The International Handbook of Suicide Prevention: Research, Policy and Practice

By Rory C. O’Connor; Jane Pirkis | Go to book overview

19
Therapeutic Alliance
and the Therapist

Konrad Michel


Introduction

In view of the high long-term risk of suicidal behavior in individuals with a history of attempted suicide (Owens, Horrocks, & House, 2002), this population must clearly be a main target group for clinical suicide prevention. So far, it has been difficult to demonstrate that specific treatments for these patients are effective (Arensman et al., 2001; Brown & Jager-Hyman, 2014). From the few studies of formalized treatments that have demonstrated a reduction in suicidal behavior, most had a follow-up period of only 6 or 12 months (Guthrie et al., 2001; Salkovskis, Atha, & Storer, 1990; Slee, Garnefski, Van der Leeden, Arensman, & Spinhoven, 2008; van Heeringen et al., 1995), although there are now some studies with longer follow-up periods (Brown et al., 2005; Fleischmann et al., 2008; Rudd et al., 2015). The reasons for the limited effect of therapies for individuals at high risk of suicidal behavior are manifold (Goldney, 2000; de Leo, 2002). One of them, although well known to experienced clinicians, tends to get little attention: the fact that suicide and attempted suicide as human phenomena do not fit into the traditional illness model, but are forms of behavior, which require of the therapist a different therapeutic approach from that used when treating “common” psychiatric disorders. This chapter will focus on principles of the therapeutic relationship with suicidal patients, drawing from clinical experience and research-based insights. A suicide attempt is defined as a “self-inflicted, potentially injurious behavior with a nonfatal outcome for which there is evidence (either explicit or implicit) of intent to die” (Silverman, Berman, Sanddal, O’Carroll, & Joiner, 2007, p. 273).


Problems in the Communication of Suicidal Intent

The encounter between the suicidal patient and the clinician is far from straightforward. Although suicidal individuals frequently visit health professionals before acting on their suicidal impulses, suicide is rarely addressed in consultation. In a psychological autopsy study of 571 suicides in Finland, in which a health-care professional had been contacted prior to the suicide, Isometsä and colleagues (1995) found that at the last visit the issue of suicide had been discussed in only 22% of the cases (39% in psychiatric

The International Handbook of Suicide Prevention, Second Edition. Edited by Rory C. O’Connor and Jane Pirkis. © 2016 John Wiley & Sons, Ltd. Published 2016 by John Wiley & Sons, Ltd.

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